INTRODUCTION: The aim of the present study was to quantify the impact of different dietary factors on the mortality from ischaemic heart disease in Denmark. METHODS: Relative risks and knowledge on the distribution of different dietary factors were used to estimate etiological fractions. RESULTS: It is estimated that an intake of fruit and vegetables and saturated fat as recommended would prevent 12 and 22%, respectively, of deaths from ischaemic heart disease in Denmark. An intake of fish among those at high risk for ischaemic heart disease, would lead to a 26% lower mortality, while alcohol intake among abstainers would have no significant quantitative effect. DISCUSSION: These results suggest that changes in dietary habits according to current recommendations would have an impact on public health in Denmark.
OBJECTIVE: To examine the quantitative agreement between a 7 day food record and a diet history interview when these are conducted under the same conditions and to evaluate whether the two methods assess habitual diet intake differently among subgroups of age and body mass index (BMI). DESIGN: Cross-sectional study. SETTING: Population study, Denmark. SUBJECTS: A total of 175 men and 173 women aged 30-60 y, selected randomly from a larger population sample of Danish adults. INTERVENTIONS: All subjects had habitual diet intake assessed by a diet history interview and completed a 7 day food record within 3 weeks following the interview. The diet history interview and coding of records were performed by the same trained dietician. MAIN OUTCOME MEASURE: Median between-method difference in assessment of total energy intake, absolute intake of macronutrients, and nutrient energy percentages. Difference between reported energy intake from both methods and estimated energy expenditure in different subgroups. RESULTS: Energy and macronutrient intake was assessed slightly higher by the 7 day food record than by the diet history interview, but in absolute terms the differences were negligible. The between-method difference in assessment of total energy intake appeared to be stable over the range of age and BMI in both sexes. As compared to estimated total energy expenditure, both diet assessment methods underestimated energy intake by approximately 20%. For both methods the under-reporting increased by BMI in both sexes and by age in men. CONCLUSIONS: Energy and macronutrient intake data collected under even conditions by either a 7 day food record or a diet history interview may be collapsed and analysed independent of the underlying diet method. Both diet methods, however, appear to underestimate energy intake dependent on age and BMI. SPONSORSHIP: Danish Medical Research Council, the FREJA programme.
In 1988-1989, 202 men and women aged 70-75 years and living in the Municipality of Roskilde participated in a dietary interview investigation. The investigation revealed that the diets of elderly persons contained a great deal of fat as 41% of the energy came from fats. The protein intake was adequate while the intake of carbohydrates, including dietary fibers was low. As regards the intake of vitamins and minerals in the diet, the supplies of vitamin A and calcium were sufficient and the vitamins B1, B2 and C and iron were acceptable. On the other hand, the intake of vitamin B6 and vitamin D were low as compared with the recommended values. 10-15% of the elderly persons ate very little and were at a particular risk of developing deficiency conditions because the low energy intake was associated with an absolutely lower nutrient intake. Elderly persons who eat least constituted a composite group as regards social background, physical activity, relative weight and self-assessment of health. 62% of the elderly persons took one or more dietary supplements daily with vitamins and minerals (corresponding to one vitamin tablet daily). No differences were observed between the users' and non-users' average intake of nutrients via the diet. The persons who employed dietary supplements thus did not have any particularly low intake of nutrients so that they had special dietary requirements.
In 1989, 674 schoolchildren aged 12-14 years in nine elementary schools in a municipality in Copenhagen, Denmark, answered a questionnaire about their dietary habits and knowledge. The majority of the pupils had fruit (87%), vegetables (72%), rye bread (81%), and drank fat-reduced milk (73%) every day. A diet score (reliability = 0.58) was calculated on the basis of the intake of 8 food items relevant to current dietary recommendations. There were no age and sex differences as to dietary habits, but immigrant children had a lower diet score than native children. Dietary knowledge was measured by the ability to state correctly whether 11 different food items had a high content or not of fat, sugar or dietary fibres. Dietary knowledge was highest for questions about fat and sugar. A knowledge score measured the number of correct answers to all 33 questions (reliability = 0.90). Knowledge was highest among older children, native children, and children with the most healthy dietary habits. In the multivariate regression analysis, knowledge, health attitudes and ethnicity were the only significant predictors of dietary behaviour. It is concluded that both social and personal factors are important for dietary behaviour, and health promotion in children should include other methods than educational programmes.
The analysis of dietary patterns emerged recently as a possible approach to examining diet-disease relation. We analysed the risk of all-cause and cardiovascular mortality associated with dietary patterns in men and women, while taking a number of potential confounding variables into account. Data were from a prospective cohort study with follow-up of total and cause-specific mortality. A random sample of 3698 men and 3618 women aged 30-70 years and living in Copenhagen County, Denmark, were followed from 1982 to 1998 (median 15 years). Three dietary patterns were identified from a twenty-eight item food frequency questionnaire, collected at baseline: (1) a predefined healthy food index, which reflected daily intakes of fruits, vegetables and wholemeal bread, (2) a prudent and (3) a Western dietary pattern derived by principal component analysis. The prudent pattern was positively associated with frequent intake of wholemeal bread, fruits and vegetables, whereas the Western was characterized by frequent intakes of meat products, potatoes, white bread, butter and lard. Among participants with complete information on all variables, 398 men and 231 women died during follow-up. The healthy food index was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling for confounding variables. The Western pattern was not significantly associated with mortality. This study partly supports the assumption that overall dietary patterns can predict mortality, and that the dietary pattern associated with the lowest risk is the one which is in accordance with the current recommendations for a prudent diet.
In 1989, 674 school pupils in the sixth and eight grades in nine elementary schools replied to a questionnaire with questions about dietary habits and knowledge. More than 70% of the pupils preferred skim-milk products to full milk. Half of the pupils always used butter or margarine on bread. The main reason for using some form of fat on the bread was that, without this, the bread would become too dry. Approximately 75% of the pupils ate brown bread, fresh fruit and vegetables daily. These same pupils had "healthy" dietary habits in many respects. 75% of the pupils avoided one or more types of food because they considered that these were not good for them. The item most frequently avoided was fat meat. 83% of the pupils included some foodstuffs in the diet because they considered that these were good for them. The items most frequently involved were fruit and vegetables. The sex and age differences between the actual diet and the ideal diet were insignificant. More than half of the pupils could state correctly whether 11 different foodstuffs contained much fat, sugar or dietary fiber. No connection was found between the pupils' dietary knowledge and their actual or ideal diets. It is thus probable that dietary advice which emphasizes foodstuffs e.g. eat more dietary fiber, is difficult for them to understand and live up to. More definite dietary information e.g. eat more vegetables, would probably have been easier for the pupils to understand and live up to. School pupils of today are very much aware of the significance of diet for their health.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: To understand the food patterns of smokers, passive smokers, and nonsmokers is important for health professionals who are assessing disease risks and for those educating individuals regarding healthy lifestyles. This study aimed to investigate the role of smoking behavior on the food intake of men and women, including the smoking habits of their partner. METHODS: Information on food intake and smoking behavior was collected by self-administered questionnaires from a cohort of 40- to 70-year-old representatives of the suburban Danish population (n = 2,656), cross-sectionally in 1993-1994. RESULTS: Men and women who smoked were less frequent consumers of fruit, raw vegetables, whole-meal bread, cakes, jam, and tea and were more frequent consumers of white bread, meat, coffee, and beer than nonsmokers. The intake frequencies of meat, fruit, raw vegetables, whole-meal bread, cakes, jam, coffee, and beer among men and of white bread and coffee among women were also associated with their partner's smoking behavior, and for these foods, the intakes of subjects living with a partner with discordant smoking behavior represented a compromise between the food patterns of smokers and nonsmokers. The associations were independent of potential confounders such as age, educational level, and physical exercise. CONCLUSION: The dietary habits of both men and women are associated with their own and their partner's smoking behavior, independent of age, education, and exercise. Epidemiological studies of smoking and passive smoking-disease relationships should account for the possible confounding by diet.
OBJECTIVE: This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns. DESIGN: A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1. SETTING: Copenhagen County, Denmark. SUBJECTS: A random sample of 7316 adults participated in health examinations conducted either in 1982-1984, 1987, or 1991-1992. RESULTS: The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase)=0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR=1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs. CONCLUSIONS: This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.
OBJECTIVE: To examine whether self rated health confounds or modifies the relation between a prudent food intake pattern and mortality and to study whether the prudent food intake pattern predicts subsequent changes in self rated health. DESIGN: A prospective cohort study with follow up of total mortality and changes in self rated health. Food intake patterns were identified by principal component analysis from a 28 item food frequency questionnaire, collected at baseline. SETTING: MONICA surveys, Copenhagen County, Denmark. PARTICIPANTS: A random sample of 3698 men and 3618 women aged 30-70 years were followed up from 1982 to 1998 (median 15 years). MAIN RESULTS: Among participants with complete information on all variables 18% had rated their health as poor (average or bad) at the baseline examination. Poor self rated health was related to a low score on the prudent food intake pattern, which was characterised by a frequent intake of wholemeal bread, fruit and vegetables. Three hundred and seventy six men and 210 women died during follow up. Poor self rated health and a low prudent food score were associated with increased mortality in both men and women. Self rated health did not modify the relation between diet and mortality. Of the 1098 men and 1048 women with good self rated health at baseline, 243 men and 297 women reported poor health during follow up. Low prudent food score, smoking, and high BMI increased the risk of developing poor health in both men and women, but in multivariate analysis the associations attenuated and were only significant for BMI. CONCLUSION: Both prudent food intake pattern and self reported health are independent predictors of mortality. Self rated health does not seem to modify the relation between diet and mortality.